Dispersed HLA variability and the making of solidarity in umbilical cord blood collection in Italy

Abstract Umbilical cord blood (UCB) is a source of hematopoietic stem cells used as an alternative to bone marrow transplantation for the treatment of hematological malignancies, blood disorders, and bone marrow failure. UCB is particularly valuable for patients from ethnic minorities who are underrepresented in international bone marrow donor registries. In response, national public UCB banking systems have developed strategies to increase the number of UCB units with human leukocyte antigen (HLA) haplotypes compatible with those of minority populations. This article examines the social implications of the strategies adopted in Italy to capture HLA variability through UCB banking. It argues that the country’s dispersed, territorially distributed network of UCB collection sites operates on a principle of generalized solidarity that enables the capture of HLA variability while mitigating the biases associated with residential segregation and healthcare inequalities. The article ultimately demonstrates that the UCB collection network is not merely a biomedical infrastructure, but a socio-political one.